Healthcare Provider Details

I. General information

NPI: 1568918951
Provider Name (Legal Business Name): KAREN ANNE CARPENTER CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2016
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6512 E WASHINGTON ST INDIANAPOLIS, IN
INDIANAPOLIS IN
46219-6633
US

IV. Provider business mailing address

4130 EAGLE COVE EAST DR
INDIANAPOLIS IN
46254-4682
US

V. Phone/Fax

Practice location:
  • Phone: 317-525-8388
  • Fax: 317-377-4706
Mailing address:
  • Phone: 317-525-8388
  • Fax: 317-377-4706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT20902272
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: